Early childhood caries (ECC) is the most common chronic disease among young children who are less than 71 months of age and is currently represented as a public health problem in various countries worldwide. Dental caries continues to be a major health problem in developing nations because of lack of education, awareness, and poor socioeconomic status. It begins with white-spot lesions on upper primary incisors along the margin of the gingiva and leads to complete destruction of the crown. The potential impact of ECC on the general health and development has been widely reported in the literature. The main risk factors in the development of ECC can be categorized as microbiological, dietary, genetic, behavioral, and environmental. Evidences for effective ECC prevention suggest prenatal and immediate postnatal interventions. Population-based early childhood health systems hold great potential to reduce the burden of ECC. This chapter focuses on diagnosis, prevalence, etiology, preventive strategies, and treatment options of ECC.